How to quit smoking: Several tries usually needed before success

He quit his pack-a-day habit because he has watched cigarettes hurt too many people, including his grandparents, who died of lung cancer, he said.

Wolbert signed up for a seven-week group therapy program called "Freedom From Smoking" at Washington University in St. Louis.

This is Wolbert's third attempt at quitting. The first two times, his doctor prescribed Chantix, a drug that blocks nicotine receptors in the brain, and wished him luck.

Health and family organizations believe that the economic downturn and higher tobacco taxes make this a good time for health-care providers to help people like Wolbert quit smoking. And yet, they say, that's not happening.

The American Legacy Foundation in Washington, D.C., which focuses on family health and wellness, conducted a recent survey of smokers. It found that about 70 percent of Americans are thinking about quitting, but only 32 percent have talked to a health-care provider about it.

And even when they did, slightly more than a third were offered prescriptions for over-the-counter nicotine-replacement products or prescription drugs such as Chantix. Only 15 percent were offered self-help materials, informed about classes and counseling programs, shown a video about quitting or referred to a cessation specialist.

Matthew Kuhlenbeck, program officer with the non-profit Missouri Foundation for Health, attributes this to a "don't ask don't tell" attitude in doctors' offices.

Experts point to embarrassment on the part of smokers who have tried unsuccessfully to quit in the past as one reason they don't bring it up.

"Maybe it's OK for them to ask their doctor for help the first time, but what happens when you go back a year later and say, 'I need another prescription,' or 'I need to try again,' " said Michelle R. Bernth, spokeswoman for the American Lung Association. "It adds another layer to the smoking cessation that's not there with other conversations in doctors' offices. Although it's completely normal to have to try six to nine times, a lot of people view it as a failure."

A lot of smokers think they can quit cold turkey.

James Harris, a retired gas company supervisor, tried and succeeded 22 years ago.

"I didn't talk to a doctor about it," he said.

According to the American Lung Association, a number of states cover counseling and smoking cessation products for state employees and Medicaid clients. Some require private insurers to cover such programs.

"Doctors should be referring them to a counselor who can talk about when and why they smoke," Kuhlenbeck said. "What are the triggers? Then you balance that counseling with pharmaceutical therapies and figure out how they affect the smoker."

In Obama's case ... What were the odds that President Barack Obama could make good on a vow to his family to give up a 30-year habit right before assuming such a demanding job? "Highly improbable," said Ovide Pomerleau, a professor of psychiatry and nicotine addiction expert at the University of Michigan. "It doesn't surprise me, given his heroic schedule of activities, that he would have some trouble giving up something that has been an easy crutch to carry him through for so many years."